Septic arthritis of the hip-Most common hematongenous spread- Up to 20% of patients with non-gonococcal septic arthritis will have 2 or more joints involved –> always do a full musculoskeletal exam!- 50% will have positive blood cultures –> always obtain cultures.- Risk factors: Extremes of age, hardware/recent instrumentation, skin infection, underlying arthritis, IV drug use- You cannot rule out septic arthritis with inflammatory markers or any physical exam findings, so err on the side of obtaining joint fluid.

Pediatric pericardial effusion/pericarditis1) Kids with chest pain also hide gremlins2) Consider bedside echo for all pediatric chest pain visits!3) Effusions of 500cc, circumferential, or 2 cm on CT scan are by definition LARGE and likely mandate admission and stat echo looking for tamponade4) Ultrasound guidance for bedside pericardiocentesis is the new standard5) Be vigilant in sign outs, always add an update note

Abdominal pigtail placement1) Small bore seldinger technique makes abdominal placement more likely, you can't finger sweep2) Consider clamping the introducer needle at the skin once air is aspirated to avoid unintentional advancement3) Remember the triangle of safety, go as high as possible with pigtails4) In the event of an abdominal mishap, scan the region and discuss with surgery

Headache with ICH/IVH1) Be wary of the "different" migraine2) Deep brain structure bleeding is associated with intraventricular extension3) IVH carries a 20-50% in hospital mortality4) ABCs, potential emergent EVD placement5) Even though a CT head is negative within the window, the LP may give you additional information that makes the diagnosis (opening pressure, cell counts, etc)